Current Medical Imaging - Volume 19, Issue 6, 2023

Malignancy, one of the leading causes of death worldwide, accounts for 9.6 million deaths in 2018. Around 1 out of 6 deaths are the direct result of the malignancy. Clinicians claim that age and breast density are two preliminary factors increasing the risk of cancer. The mortality rate brought about by malignant growth in low and high income countries is, for the most part, around 70%. Imaging techniques play a vital role in the detection, and staging, thereby helping in treatment decision making. This review paper presents a comprehensive survey involving a literature study about the evolution and efficacy of various breast cancer detection techniques. This work studies various procedures of imaging techniques such as mammograms, ultrasound, MRI, PET, CT, Terahertz Spectroscopy, Raman Spectroscopy, Optical coherence Tomography, Mass spectroscopy, diffuse reflectance spectroscopy, and Infrared Thermography. Since cancer is a complicated illness with diverse pathophysiologies, numerous modifications of the fundamental detection approach employed in each of these modalities have been performed throughout the years to increase the detection efficiency. This paper covers basic preliminary results with FFPE breast cancer blocks of malignant and normal subjects using THz Techniques that are presented as proof of concept to carry out further research.

Background: In recent years, Alzheimer's Disease (AD) has received more attention in the field of medical imaging, which leads to cognitive disorders. Physicians mainly rely on MRI imaging to examine memory impairment, thinking skills, judge functional abilities, and detect behavioral abnormalities for diagnosing Alzheimer's disease. Objective: Early diagnosis of AD has become a challenging and strenuous task with conventional methods. The diagnostic procedure becomes complicated due to the structure and heterogeneous dimensions of the brain. This paper visualizes and analyzes the publications on AD and furnishes a detailed review based on the stages involved in the early detection of the disease. Methods: This paper also focuses on assorted stages of disease detection such as image preprocessing, segmentation, feature extraction, classification, and optimization techniques that have been used in the diagnosis of AD during the past five years. It also spotlights the deep learning models used in assorted stages of detection. This paper also highlights the benefits of each method for assorted modalities of images. Results: AD has been analyzed with various computational methods on a few datasets, which leads to high computation time and loss of important features. Hybrid methods can perform better in every diagnosis stage of AD than others. Finally, the assorted datasets used for the diagnosis and investigation of Alzheimer's disease were analyzed and explored using a computerized system for future scope. Conclusion: From the review papers, we can conclude that DNN has greater accuracy in MR images and CNN +AEC has the best accuracy in the multimodal images.

Background: Breast cancer is the most common malignancy and the second most common cause of death in women worldwide. Axillary lymph node metastasis (ALNM) is the most significant prognostic factor in breast cancer. Under the current guidelines, sentinel lymph node biopsy (SLNB) is the standard of axillary staging in patients with clinically-node negative breast cancer. Despite the minimally invasive nature of SLNB, it can cause short and long-term morbidities, including pain, sensory impairment, and upper limb motor dysfunction. However, lymphedema remains the most feared adverse event, and it affects 7% of patients within 36 months of follow-up. Recently, we have witnessed the implication of radiomics and artificial intelligence domains in the diagnosis and follow-up of many malignancies with promising results. Therefore, we have conducted a systematic search to investigate the potential of radiomics and artificial intelligence in predicting ALNM. Methods: Four electronic databases were searched: PubMed, Scopus, CINAHL, and Web of Science. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis as our basis of organization. Results: For radiomics, the area under the curve (AUC) for the included studies ranged from 0.715 to 0.93. Accuracy ranged from 67.7% to 98%. Sensitivity and specificity ranged from 70.3% to 97.8% and 58.4% to 98.2%, respectively. For other artificial intelligence methods, AUC ranged from 0.68 to 0.98, while accuracy ranged from 55% to 89%. Conclusion: The results of radiomics and artificial intelligence in predicting ALNM are promising. However, validation as a substitute for SLNB requires more substantial evidence from large randomized trials.

Background: Primary breast lymphoma (PBL) is a rare malignant breast tumor. The literature concerning PBL ultrasound is based primarily on case reports, with only a few cases reported to date. Purpose: This study aimed to elucidate the sonographic characteristics of PBL and explore the value of ultrasonography in the preoperative diagnosis of PBL using the Breast Imaging Reporting and Data System (BI-RADS). Methods: A retrospective review of files involving a diagnosis of PBL (2013–2020) was conducted in the Department of Pathology, Zhejiang Provincial People’s Hospital, Hangzhou, and the First Affiliated Hospital of Wenzhou Medical University, Wenzhou. The clinical characteristics and sonographic features of 12 lesions in 10 patients were analyzed and discussed in light of the literature. Results: All patients, aged 50.40 ± 14.31 years (range 30–66 years), had clinically palpable lumps. Most cases were on the right breast and were unilateral. Only one patient had mucosa-associated lymphoma. The histological type of the other patients was diffuse large B-cell lymphoma (DLBCL). Ultrasonography revealed nodular and diffuse PBL lesions without internal calcification. The nodular PBL was hypoechoic or mixed hypo- to hyperechoic, with a differential lobulated shape and horizontal growth. Although color Doppler flow imaging (CDFI) showed no significant features, the ultrasound findings were categorized as BI-RADS 4 in 10 of the 12 lesions and BI-RADS 5 in two lesions. All patients were suspected of having malignancies (BI-RADS 4 or 5). Conclusion: PBL was mostly found in middle-aged and elderly women, and the right breast was more prone to the development of malignancies. PBL lesions were classified as either nodular or diffuse based on the boundaries of the tumors in the ultrasound images. Typical PBL was characterized by hypoechoic or heterogeneous lesions with circumscribed or microlobulated margins and horizontal growth. The sonographic features of the PBL lesions and the BI-RADS categorizations of the lesions analyzed suggested malignancy.

Background: This study is focused on establishing a relationship between poor muscle activity faced by obese individuals due to the change in stiffness of the intramuscular mass of the lower limb. This issue is also common among athletes and physically active teenagers. Objective: The study is aimed at a subject assessment diagnosis technique named as Strain Elastography (SE) to measure muscle strain. Further, Finite Element Modelling (FEM) technique is used to investigate the strain and/or deformations generated in the Achilles Tendon (AT) models, which were categorized according to their Body Mass Index (BMI) through computationally applied loadings. Methods: Total 54 volunteers with an average age of 21.85 ± 1.28 years were categorized into three groups according to their BMI (kg/m²); under BMI < 18.5 (n=14), normal BMI = 18.5-24.9 (n=20) and over BMI/obese > 25.0 (n=20). Additionally, multiple correlational analyses were performed between full range of BMI values and SE outcome. Results: The presence of significant difference (p<0.05) was measured between different categories for BMI, BFMI, FFMI, DLFC, tendon length, tendon thickness and SR. Moreover, multiple correlational analyses and scatter plot strengthen the results. For FEM simulations, the maximum deformation was observed at the proximal end of the tendon in all three groups. Conclusion: It can be concluded that change in tendon stiffness and the resulting change in tendon structure was visualized with increased BMI. Moreover, obese individuals are more prone to tendon injury due to the increment in tendon thickness which causes bulging of the AT due to higher loads.

Objective: Accurate preoperative prediction of sinonasal inverted papilloma (SNIP) malignant transformation is essential and challenging. In this study, 3.0T magnetic resonance was used for qualitative, quantitative, and multi-parametric analysis to evaluate the predictive value of magnetic resonance imaging (MRI) in malignant transformation. Methods: The data of patients with SNIP (n=83) or SNIP-transformed squamous cell carcinoma (SNIP-SCC) (n=21) were analysed retrospectively. Univariate analysis and multivariate logistic regression were used to establish models to predict the risk factors for the malignant transformation of SNIP. Receiver operating characteristic (ROC) curves were used to evaluate the ability of independent risk factors and related combination models to predict the malignant transformation of SNIP. Results: Convoluted cerebriform pattern (CCP) mutation, apparent diffusion coefficient ratio (ADCr), and wash-in index (WII) 2 and 3 were independent risk factors for predicting malignant transformation of SNIP, with area under the ROC curve (AUC) values of 0.845, 0.862, 0.727, and 0.704, respectively. The AUC of the quantitative parameter model combined with ADCr and WII 2 and 3 was 0.910 for diagnosing malignant transformation. The AUC of the comprehensive model comprising all independent risk factors was 0.937, with a sensitivity, specificity, and accuracy of 90.48%, 90.36%, and 92.31%, respectively. Conclusion: Compared with assessing independent risk factors of CCP mutation, ADCr and WII, and the quantitative parameter model, the comprehensive model could improve the differential diagnosis ability of SNIP and SNIP-SCC, which provides an important imaging basis for the possible accurate preoperative evaluation of the malignant transformation of SNIP.

Background: Trigeminal neuralgia (TN) is a common cranial nerve disease. Objective: To investigate the relationship between the trigeminal nerve and the responsible blood vessel in patients with unilateral vascular trigeminal neuralgia (VTN). Methods: Thirty patients with unilateral VTN were confirmed by microvascular decompression. Results: Among the 30 patients, the responsible blood vessels were present in 30 cases on the affected side and 17 cases on the uninfected side (1). The location of the intersection of the trigeminal nerve and the responsible blood vessel: the affected side is located 2/5 behind the trigeminal nerve cisternal segment; the healthy side is located 3/5 anterior to the cisternal segment (2). Symptomatic vessels were located within the cistern between the origin and 2/5ths of the cistern length, and non-symptomatic vessels were located beyond the 2/5ths location (3). Direction of intersection: on the affected side, the responsible vessel was located inside and above the trigeminal nerve in 27 cases, (27/30, 90%), and outside and below the trigeminal nerve in 3 cases (3/30, 10%). On the unaffected side, the responsible vessel was located inside and above the nerve in 16 cases (16/17, 94%) and outside and below the nerve in 1 case (1/17, 5.8%) (4). Intersection form: 3 cases (3/30, 10%) on the affected side, the responsible blood vessel contacted the trigeminal nerve, in 26 cases (26/30, 86%) the responsible blood vessel compressed the trigeminal nerve, and in 1 case (1/30, 5%) the responsible blood vessel caused the trigeminal nerve to be twisted; 8 cases (8/17, 47%) of the contralateral side contacted the trigeminal nerve with the responsible blood vessel, and in 9 cases (9/17, 53%) the responsible blood vessel compressed the trigeminal nerve. Conclusion: Patients with unilateral VTN have differences in the location and form of the intersection of the trigeminal nerve and the responsible vessel on the affected side and the contralateral side.

Background: Colorectal cancer is a malignancy that affects the gastrointestinal tract. Clinical diagnosis has routinely been done with colonoscopy in conjunction with digital rectal and histological examinations. Objective: We show that CT, MRI, and MRI-DWI are all effective in T-staging colorectal adenocarcinoma when compared to pathology examination. However, differences in the detection and diagnostic agreement rates between the imaging modalities for the specific T-stages were observed. Methods: Fifty-six patients diagnosed with colorectal adenocarcinoma and underwent contrastenhanced abdominal CT, non-contrast MRI, or MRI-DWI between January 2014 and March 2020 were retrospectively examined and compared to a biopsy or postoperative pathological T-stage. Results: The total diagnostic agreement rate for CT, MRI, and MRI-DWI were 58.93%, 76.79%, and 85.71%, respectively. T-staging was statistically and significantly different across all four stages analyzed for all imaging modalities. The T1-stage for MRI and MRI-DWI compared to pathology rates were statistically significant, whereas MRI-DWI and CT both demonstrated statistical significance for T3 and T2 stage comparison, respectively. Furthermore, a statistical and significant difference between the total stage comparison of MRI, MRI-DWI, and CT compared individually to pathology was also observed. All imaging modalities were able to statistically and significantly identify tumors based on tumor size according to the ROC analysis. Conclusion: These data suggest that CT, MRI, and MRI-DWI can identify and aid visually in the diagnosis of adenocarcinoma colorectal cancer. MRI-DWI is more specific and sensitive in the diagnosis and staging of colorectal tumors.

Objective: To investigate the effect of mesioangular impaction of the mandibular third molars on distal caries and distal bone loss (DBL) in the adjacent mandibular second molars to provide a basis for prophylactic impacted third molar extraction. Methods: We retrospectively analyzed panoramic radiographs of 736 patients with mesioangularly impacted mandibular third molars at the Department of Stomatology, Shanghai Fifth People’s Hospital. The chi-square test, the Kruskal-Wallis test, and logistic regression were performed to analyze the relationship of patient age, sex, mesial inclination angle, distal caries, and DBL in the mandibular second molars. Results: Patient aged over 30 years and a mesial inclination angle > 30° were risk factors for distal caries in the mandibular second molars (p < 0.05). Patients aged over 20 years and a mesial inclination angle of 60°-90° were risk factors for DBL (p < 0.05). Conclusion: In patients with mesioangularly impacted mandibular third molars, age and the mesial inclination angle were positively correlated with the severity of distal caries and DBL in the adjacent mandibular second molars. These findings could guide dental practitioners to prevent complications of the adjacent molars during early prophylactic extraction of the mandibular third molars with mesioangular inclination.

Background: The most common etiology of shoulder pain in adults is rotator cuff tear. Elastography is an imaging method that can report the strain and elastic modulus of the biological tissue. We think acoustic radiation force impulse (ARFI) elastography can effectively assess rotator cuff tendinopathy. Purpose: This study aimed to investigate the usefulness of ARFI elastography in evaluating supraspinatus tendinopathy. Materials and Methods: We included 44 patients (22 men, 22 women, median age, 47 years; range, 20-69 years) with unilateral supraspinatus tendinopathy diagnosed with magnetic resonance imaging (MRI) in this prospective study. The normal tendons and tendinopathies, including supraspinatus tendinosis, partial-thickness, and full-thickness supraspinatus tears, were evaluated with ultrasound and ARFI elastography. The ARFI elastography values were compared between healthy and tendinopathy groups, and the gender was compared between elastography values of the normal tendons and tendinopathies using the Mann-Whitney U test. Results: The values of ARFI elastography correlated with tendinopathy. (P = 0.001). The gender differed between the elastography values of the normal tendons (P = 0.002) and tendinopathies (P = 0.001). Conclusion: ARFI elastography is a non-invasive and feasible method for quantitatively assessing supraspinatus tendinopathy. It can be an alternative method to MRI in diagnosing supraspinatus tendinopathy.

Background: Internuclear ophthalmoplegia (INO) is a disorder of eye movements caused by a lesion involving the medial longitudinal fasciculus (MLF) within the brainstem, and it is characterized by adduction impairment combined with contralateral dissociated abduction nystagmus. The frequency of acute ischemic stroke (AIS) presenting with INO as a predominant symptom is very low, and many patients suffering from this brainstem AIS are precluded from intravenous thrombolysis (IVT). Objective: To provide for the first time a magnetic resonance imaging (MRI) evidence of response to the IVT in brainstem wake-up stroke presenting with INO as an isolated symptom. Methods: Here, we described a rare case of pons AIS presenting with INO as a unique symptom of awakening. In order to differentiate an ischemic stroke from other stroke mimics, and to determine whether the patient was within the therapeutic window for IVT (wake-up stroke), brain MRI including DWI and FLAIR sequences was acquired. Results: A left paramedian pontine DWI/FLAIR mismatch was detected and the patient was considered eligible for IVT. After IVT, the patient made a full recovery with complete resolution of INO. Follow-up MRI at 1 month demonstrates the absence of ischemic lesions. Conclusion: Our case provides neuroradiological evidence of IVT efficacy in brainstem stroke, and it should prompt clinicians to rapidly perform MRI in wake-up onset INO and to just as quickly administer IVT, since INO is a functionally disabling deficit. Finally, this case demonstrates the value of MRI in diagnostic, prognostic, and therapeutic workup of posterior circulation wake-up stroke.

Background: Splenosis refers to the autotransplantation of splenic tissue in a heterotopic location throughout different anatomic compartments, such as the peritoneal and pelvic cavities and even the thoracic cavity. Intrahepatic splenosis is very rare and usually mistaken for a neoplasm. The lack of typical radiological features makes it difficult to distinguish splenosis from liver tumors. Case Report: A 33-year-old female patient presented with post-traumatic splenectomy and had a history of recurrent surgery afterward. There were no significant findings in the physical examination or lab values. Imaging findings were non-specific, with nodular lesions in the liver and scattered in the abdomen. Due to the patient’s history, splenosis was considered in the differential diagnosis, and finally, scintigraphy was performed, which confirmed the diagnosis, so unnecessary surgery was avoided. Discussion: Splenosis is the implantation of splenic tissue after an elective or traumatic splenic rupture. US imaging indicates a hypoechoic to isoechoic mass. Low signal intensity on T1 and iso-to-high signal intensity on T2-weighted images are common MRI findings of splenosis. The arterial phase of spleen implantation is varied. Delayed phase signal intensity is usually less than the liver parenchyma. The spleen has the lowest ADC value and the most restricted diffusion of all the intra-abdominal organs. Conclusion: In conclusion, splenosis should be considered in the differential diagnosis of patients with a history of spleen surgery or abdominal trauma. It should correlate with the clinical history.

Introduction: Limited experience exists regarding the clinical features of focal lipogranuloma inflammation of the lung, and there are no supporting guidelines for the diagnostic approach. Case Description: We present the case of a 20-year-old man who was found to have a pulmonary nodule with a smooth margin during a health examination. He underwent wedge resection of the left lower lung to achieve a tissue diagnosis; this showed focal lipogranuloma inflammation of the lung. Conclusion: In this report, we combined imaging and pathological findings to reach the diagnosis, with a view to assisting clinicians in navigating this challenging clinical situation.

Background: Benign lesions cause ovarian torsion more commonly than malignant ovarian tumors. Further, Krukenberg tumors have rarely been reported to cause ovarian torsion. Case Presentation: Herein, we present the case of a patient with an incidentally discovered ovarian mass, which was finally diagnosed as a Krukenberg tumor accompanying ovarian torsion with primary stomach cancer. We further review the clinical, imaging, and histological features of Krukenberg tumors. Conclusion: Radiologists should be aware of Krukenberg tumors that may present with ovarian torsion.

Introduction: Hemangioblastomas are highly vascular benign tumors that may increase in size during pregnancy. The concurrence of cerebellar hemangioblastoma in high-risk pregnancy is extremely rare and the treatment in this situation can be challenged. Case: Here, we report a case of a 30-year-old woman in the 33rd PW who had experienced a severe headache, dizziness, vomiting, and limb weakness. Cesarean section was performed in the 34th PW, followed by neurosurgery under multidisciplinary discussion. Discussion: The pathological exam suggested hemangioblastomas. Finally, both the pregnancy and the fetus had a good outcome. Conclusion: This case emphasizes that the timing of surgery should be determined according to the neurological symptoms of the pregnancy and the gestational age (GA) and condition of the fetus.

Background: Fetal ultrasonographic evaluation is a routine part of pregnancy follow-up, and examination of orbital structures is also part of the routine evaluation. Although orbital developmental anomalies are common in the neonatal period, diagnosis in the intrauterine period is not common. To our knowledge, three cases with a diagnosis of congenital orbital epidermal cysts have been reported in the literature, and two of them had fetal imaging findings. In this article, we present the prepostnatal imaging findings of a case diagnosed with orbital cyst in the fetal period and histopathologically diagnosed as epidermal cyst in the neonatal period. Case Report: A 25-year-old woman applied for ultrasonography (USG) examination at 22 weeks of gestation. A 35x45 mm cystic lesion causing proptosis, without solid component and vascularity, surrounding the optic nerve and causing its thinning was observed in the left orbit. In fetal magnetic resonance imaging (MRI), the intraorbital cystic lesion, which was hyperintense on T2W images and hypointense on T1W images, had no relationship with intracranial structures and no solid component. The lesion of the patient, followed up with a multidisciplinary approach, was shown similarly with computed tomography (CT) and magnetic resonance imaging (MRI) in the postnatal period. Subsequently, the patient underwent globe-sparing surgery, and the pathological diagnosis was made as the epidermal cyst. Conclusion: Orbital epidermal cysts are rarely seen, and detection in the fetal period is even rarer. It should be considered in the differential diagnosis of orbital cystic lesions that cause proptosis in fetal and neonatal periods.

Introduction: Subdural hematoma without subarachnoid hemorrhage secondary to intracranial aneurysm rupture is rare and may complicate patient management due to delay in diagnosis and subsequent treatment. Herein, we describe a case presenting with pure SDH secondary to the rupture of a posterior communicating artery infundibular dilatation (PcoA-ID). To the best of our knowledge, this is the first case of rupture of a PcoA-ID with SDH in the convexity and tentorium, which also tracked into the upper cervical spine along the subdural space. Additionally, we briefly discuss the previously published cases of pure SDH secondary to intracranial aneurysm rupture. Case Report: A 44-year-old female presented with headache, dizziness, nausea and left-sided diplopia to an outside institution. Initial diagnostic work-up showed no intracranial hemorrhage, however, magnetic resonance angiography and subsequent digital subtraction angiography revealed left posterior communicating artery infundibular dilatation. Two days later, the patient presented with a loss of consciousness. Computed tomography was positive for bilateral hemispheric subdural hematoma with no evidence of subarachnoid hemorrhage. Digital subtraction angiography showed left posterior communicating artery infundibular dilatation and pseudoaneurysm originating from the inferior area of the infundibular dilatation, concerning recent rupture. Balloon assisted coil embolization was performed and the patient had a good outcome without any neurological deficit. Conclusion: Subdural hematoma in a young adult without a history of trauma or coagulopathy warrants additional vascular imaging to search for underlying vascular lesions. It should also be kept in mind that infundibular dilatation may rupture and cause a pure subdural hematoma.